school, we always had 'til labor day. things -- it's rough for kids these days. it's important for us to be able to compete internationally. it's great to see dedicated educators like we have here at central high. [ applause ] nathan's story was the kind of story that i read in letters and heard in town halls all across america. on tuesday i was in new hampshire talking about people denied coverage because of preexisting conditions. yesterday i was in montana talking about people who had their insurance policies suddenly revoked even though they were paying their premiums, just because they got sick. today we're talking about people like nathan and his family who have insurance, but are still stuck with huge bills because

they hit a cap on their benefits or are charged exorbitant out of pocket fees. when you hear about these experiences, when you think about the millions of people denied coverage because of preexisting conditions and the thousands who have had their policies canceled because of an illness, countless people like nathan, i want you to remember one thing, there but for the grace of god go i. [ applause ] this is something that sometimes we have forgotten during the course of this health care debate. these are ordinary americans. they're no different than anybody else. they're working hard, they're meeting their responsibilities. they're held hostage by health insurance companies that deny them coverage, or drop their coverage, or charge fees that they can't afford for care they

desperately need. it's hurting too many families. it's wrong. we're going to fix it when we pass health insurance reform this year. [ applause ] now, this is obviously a tough time for the families in colorado and all across america. i just want to rewind the clock a little bit because sometimes people have forgotten what's transpired over the last seven, eight months. just six months ago, we were in the middle of the worst recession of our lifetimes. we were losing about 700,000 jobs each month. economists from the left and the right, liberals and conservatives, feared the second

coming of the great depression. i don't know if everybody remembers that. that was six months ago. that's why we acted as fast as we could to pass the recovery plan to stop the free fall. there has been a lot of misinformation about that, so let me talk brief will he about what it is we did. the recovery plan was divided into three parts. one third of the money, one third of the money in the recovery act, the stimulus plan, went to tax cuts that are already showing up in the paychecks of nearly 2 million working families in colorado. including right here in grand junction. [ applause ] so i just want everybody to be clear. one third of it tax cuts. not tax increases. more money in your pocket to spend as you wish. we also cut taxes for small businesses on the investments that they make and hundreds of

colorado small businesses have qualified for new loans backed by the recovery act, including 11 businesses in grand junction alone. that was one third of it. now, another third of the money in the recovery act is for emergency relief for folks who have borne the brunt of this recession. so we've extended unemployment benefits for more than 150,000 colorado citizens. we've made health insurance 65% cheaper for families who are having to use cobra because they lost their jobs or are out there looking for work. [ applause ] and for budget short fall, we provide assistance of tens of thousands of workers who provide essential service, like teachers and police officers, and the

governor will tell you, if we had not had some of that money in, then colorado would have had to make much more painful job cuts in vital services and might have had to put in place some very painful state and local tax increases. that was the second third of the recovery. the last third of the recovery act was for investments that are already putting people back to work. there are almost 100 shovel ready transportation projects already approved in colorado which are beginning to create jobs. not far from here, for example. there is a project to pave and add lanes to state highway 92. most of the work is being done by local business because that's how we're going to create jobs and grow this economy again. by next month, the projects will be underway at more than 100 national parks all over america, including colorado. [ applause ]

these are projects restoring trails, improving infrastructure, making park fails more energy efficient. earlier, some of you know i toured yellowstone with michelle and the girls. we saw old faithful, i hadn't seen it since i was 11 years old. it's still going strong. tomorrow we're going to be visiting the grand canyon. i recently signed into law a public lands bill that designates the dominguez he is coo ran tee canyon a national conservation area here in colorado. [ applause ] these are national treasures, symbols of how much we owe to those who came before us and the fact we're borrowing this earth from those who will follow us. i want to thank especially ken salazar because he's been

leading the way on these, especially in the west. [ applause ] as we grapple with enormous challenges like health care, the worth of generations past reminds us -- reminds us of our duty to generations yet to come. so there is no doubt that the recovery plan is doing what we said it would. putting us on the road to recovery. not solving all problems, unemployment is still way too high. but we just saw last week that the jobs picture is beginning to -- signs that business investment is coming back. that doesn't mean we're out of the woods. even before this extraordinary financial crisis, we had an economy that was working pretty well for the wealthiest americans, working pretty well for wall street bankers, big corporations, but it wasn't working for everybody else. it was an economy, a bubble and

bust. it was an economy in which the average worker, their wages and incomes flat lined for a decade. it was an economy that rewarded recklessness over responsibility. we can't go back to that kind of economy. if we want this country to succeed in the 21st century, we've got to lay a new foundation for lasting prosperity and health insurance reform is a key pillar of this new foundation, because this economy won't work for everyone until folks like nathan and his family aren't pushed to the brink of bankruptcy by medical expenses. until companies aren't slashing payrolls and losing profits to pay for health insurance, until every single american has the security and peace of mind of quality, affordable health care. and health care touches us all

in profound ways. which, by the way, means that it's only natural that the debate will be an emotional one. there's a lot at stake. i know there has been a lot of attention paid to some of the town hall meetings going on around the country, especially those where tempers flaired and tv really likes that. you can ask 20 really great town hall meetings and if there is one where somebody loses their temper, that's the one tv wants to cover. you haven't been seeing all the constructive ones going on all over the country. it means we've been trying to figure out how do we solve what we know is an unsustainable problem in our health care system? just yesterday -- [ applause ] just yesterday i healed a town hall in montana and we had a pretty good crowd. some were supporters of reform. some had concern and questions.

some were completely skeptical. i got tough questions. but even though montana had strong opinions, they didn't shout at one another. they were there to listen. that reflects the american people. and what our democracy is about and a lot more than what what's been covered on tv the last few days. that's why i thank all of you, whether you're for or against health care reform, for being here today. i'm going to take a bunch of questions. before i do, i want to talk about what health insurance reform will mean for you. 'cause there is a lot of misunderstanding. first of all, what we're proposing is a common sense set of consumer protection for people with health insurance, people with private health insurance. i expect that after reform passes, the vast majority of americans are still going to be getting their insurance from

private insurers. so we've got to have some protections in place for people like nathan, people like you. so insurance companies will no longer be able to place an arbitrary cap on the amount of coverage you can receive or charge outrageous out of pocket expenses on top of your premiums. that's what happened to nathan. their son diagnosed with hemophilia when he was born, the insurance company raised his premiums for the family and employees. on top of worrying about taking care of their son, they had the added worry of finding insurance to cover them, plus thousands in out of pocket costs. nathan and his wife considered getting a divorce so that she might go on medicare. thankfully, colorado's law doesn't allow coverage for small businesses to permanently exclude preexisting conditions like his son's. so eventually they found insurance. but they're paying increasing

premiums. they still have to pay the prospect of hitting their new cap in the next few years. those are stories i hear all over the country. i heard from a teen-ager in indiana diagnosed with leukemia, chemotherapy and intensive care he received cost hundreds of thousands of dollars. his family hit their lifetime cap in less than a year. they had insurance. so the insurance wouldn't cover a bone marrow transplant and the family couldn't afford all the money that was needed. the family turned to the public for help, but the boy died before he could receive that transplant. if you think that can't happen to you or your family, think again. almost 90% of individual health insurance policies have lifetime benefit limits. about a third of family plans in the individual insurance have limits. if you or your spouse or child get sick you and hit that limit, it's suddenly like you have no insurance at all. this is part of the larger

story. folks with insurance paying more and more out of pocket. in the past few years, premiums have nearly doubled for the average american family. total out of pocket costs have increased by almost 60%. that's more than $2,000 per person. nobody is holding these insurance companies accountable for these practices. by the way, your employer is paying even more and you may not even see the cost of it except for the fact that's why you're not getting a raise. because it's going into your health care instead of your salary and income. so we're going to ban arbitrary caps on benefits. we'll place limits on how much you can be charged for out of pocket expenses. no one in america should go broke because they get sick. [ applause ]

insurance companies will also be stopped from canceling your coverage because you get sick or denying coverage because of your medical history. again, if you think this has nothing to do with you, think again. a recent report found that in the past few years, more than 12 million americans were discriminated against by insurance companies because of a preexisting condition. when we get health insurance reform, those days will be over. we will require insurance companies to cover routine checkups and preventive care like mammograms. that saves money and saves lives. [ applause ] at the same time, i just want to be completely clear about this, i keep on saying this, but somehow folks aren't listening.

if you like your health care plan, you keep your health care plan. nobody is going to force you to leave your health care plan. if you like your doctor, you keep seeing your doctor. i don't want government bureaucrats meddling in your health care. but the point is, i don't want insurance company bureaucrats meddling in your health care either. [ applause ] so just to recap here, if you're one of nearly 46 million people who don't have health insurance, you will finally have quality, affordable options. if you do have health insurance,

we will help make that insurance more affordable and more secure. under the remind proposals -- reformed proposals we put out, many will get a health care tax credit. more than 1 million of coloradoan also have access to a new marketplace where you can easily compare health insurance options. 87,000 small businesses in colorado will be aided by new tax benefits so when they're doing the right thing for their employees, they're not penalized for it. and we will do all of this without adding to our deficit over the next decade, largely by cutting waste and ending sweetheart deals for insurance companies that don't make anybody any healthier. i know there is some skepticism, how are you going to save money in the health care system?

you're doing it here in grand junction. you know that lowering cost is possible if you put in place smarter incentives. if you think about how to treat people, not just illness, if you look at problems facing not just one hospital or physician, but the many system wide problems that are shared. that's what the medical community in this city did. now you're getting better results while wasting less money. i know your senator michael bennett has been working hard on legislation that is working on innovation into practice across the system. there is no reason why we can't do that. so the fact is, we are closer to achieving reform than we've ever been. we have the american nurses association. we have the american medical association on board because america's doctors and nurses know how badly we need reform.

broad agreement in congress on about 80% of what we're trying to achieve. we have an agreement from drug companies to make prescription drugs more affordable for seniors. $80 billion to cut the doughnut hole that seniors have to deal with on prescription drug plans in half. [ applause ] the aarp support this is policy and agrees with us that reform must happen this year. look, because we're getting close, the fight is getting fierce. every time we're in sight of reform, special interests start fighting back with everything they've got. they use their influence, they run their ads. let's face it, they get people scared. understandably. i understand why people are nervous. health care is a big deal. in fact, when ever america has

set about solving our toughest problems, there were always those who sought to preserve the status quo by scaring the american people. that's what happened when fdr tried to pass social security. they said that was socialist. they did. # verbatim, that's what they said. they said that everybody was going to have to wear dog tags and this was a plot for the government to keep track of everybody. when jfk and lyndon johnson tried to pass medicare, they said this was a government takeover of health care. they were going to get between you and your doctor. the same argument being made today. these struggles have always boiled down to a contest between hope and fear. it was true when social security was born. it was true when medicare was created. it's true in today's debates. [ applause ]

whether you have health insurance or you don't have health insurance, we all know we can't continue down this path. costs are rising far faster than wages. a system works a lot better for insurance companies than it does for america's families. to maintain what's best about our health care system, for you to keep what you've got if you're happy with it, it's going to require change. we've got to keep what's good about the system, especially the relationship between doctors, nurses and their patients, while fixing what's broken. because for all the scare tactics out there, what's truly scary is if we don't do anything, we will continue to see 14,000 americans lose their health insurance every day. premium also continue to skyrocket, going up three times faster than your wages, the deficit will continue to grow because most of it is medicare and medicaid. medicare will go into the red in less than a decade.

insurance companies will continue to profit by discriminating against people just because they're sick. if you want a different future, a brighter future, i need your help. i need you to stand for hope. i need to you knock on doors. i need to you spread the word because we are going to get this done this year. thank you. thank you. [ applause ] >> thank you. now, i've got time for a bunch of questions. we've got a bunch of people in the audience with microphones. hold up your microphones. all right. the way we're going to do this is i'm going to go around the room, raise your hand, to be fair, i'll make sure girl, boy, girl, boy. if you can introduce yourself

and ask your question or make your comment, if you can keep your question or comment relatively brief, i will try to keep my answers relatively brief and that way we can make sure that we get through more questions during the course of this event. all right? okay. let's see hands. i'll start with this young lady right here in the pink blouse. whoops. hold on. can you check that mic? >> good afternoon, mr. president. my name is poly. i work at rocky mountain orthopedic here in grand junction. on behalf of our ceo, he would like to extend an invitation for you to visit our successful practice to see how we provide excellent health care at a lower, average cost to our

patients. my question is, the original health care health bill included funding for qualified health centers could have a budget based on -- if private physician hospitals and other providers are going to be given incentives to reduce waste in cost, what will be done to insure the government programs will do the same? >> it's an excellent question. part of what is so important about reform is that right now the way medicare and medicaid operates, if it's starting to go overbudget, we basically have two choices. either we raise taxes and just keep on paying more and more, and health care inflation is going up at least twice as fast as inflation on everything else, or what we do is we just tell the providers, we're going to give you less money, period.

we'll reimburse you 80 cents or 90 cents for every dollar of services you provide. then what happens is that the providers, they end up just charging people with private insurance to make up for the difference. so that drives everybody's cost up. what's been done here in grand junction, in other outstanding health programs like mayo is they have a delivery system so you're actually getting more bang for your health care dollar. let me give you an example. right now if you go to your doctor and you get a test, a lot of times that test won't be forwarded to the next doctor or specialist that you have to see. you have to take another test. you might have to take three or four or five tests by the time your treatment is all completed. that's a waste of money.

and if we can incentiveize the providers to say do one test and forward them to the other providers who might be doing treatment, that right there saves a lot of money. so what we want to do is to do this in medicare and medicaid, which will incentivize a lot of health systems around the country to start using some of the smart practices that you're using. frankly, medicare and medicaid, they provide a lot of care for a lot of patients, particularly seniors. so if they hear from medicare, can you start doing things smarter, they have an incentive too do it. once they put a smarter system in place, the benefits spill over to the private insurance market as well. so we want to do it through medicare and medicaid, but we also want to see it in the

private insurance market that health providers start thinking smarter and providing better care which often turns out to be lower cost care. now, it's not going to happen overnight, 'cause a lot of these systems have been put in place for a long time. and you're in grand junction or mayo clinic or geisinger or other good health care systems. each year they're continuing comparing notes, they've got a peer review process where doctors are exchanging ideas and they're continually making the system better and better, smarter and smarter and over time, what we can do is bend the cost curve so that instead of having inflation go up a lot faster on health care than everything else, it matches everything else. if we could do that, if we could just get health care inflation to match the inflation on food and other items, all of our

deficit -- long-term deficit problems would be solved. just that alone. if we could just reduce the amount of health care inflation, our long-term debt and deficit problems would be solved. this is the most important thing we can do for deficit reduction. i want everybody to remember that because in this debate you heard a lot of people saying, we can't afford to do this because our deficit is too high. the biggest driver of our deficit and debt is health care. if we don't change the delivery system and adapt some of the innovations being used where you work and in really good health care systems around the country, then we're going to be in red ink forever. okay? thank you so much for the question. [ applause ] >> all right. gentleman in the red shirt back there. wait fort mic, sir.

>> thank you, mr. president for taking my question for one. i got a bunch, but my name is randy and i had been in the health insurance business for over 25 years. i'm also a big steeleers fan as well. >> i like that. are you allowed to contest that, though, here? >> i can take it. >> you asked many times why insurance companies are so afraid of competing with a public plan option and coverage. i understand insurance companies need to get spanked every now and again for sure, but if the public plan option reimburses on average 55 cents by contract of every dollar of care to the provider, and the private insurance plans by contract reimburse an average of 85 cents per dollar of care, how can it

be considered fair competition? and thank you for being here today. >> i think it's a good question. thank you. for those of you who have not been following the debate as closely, let me just describe what this issue in the public plan is all about. to do so, i've got to describe how we're looking to provide health insurance for people who don't currently have it. i spend most of my time talking about what we would do for folks who have health insurance. we got 46 million uninsured and i think it's the right thing to do to provide them with some help. most of them work, most of them are responsible, but their employer, maybe they work for a small employer, they can't afford it because they don't have the bargaining power to get low enough rates to cover all their employees. that's a big category of the

uninsured. so what we've said is, let's set up what's called a health insurance exchange. it's essentially a marketplace where you could go on-line and you would have a menu of options. most of them private insurers, aetna, blue cross blue shield, insurance companies that wanted to participate, and they would list a range of plans just like when mike and mark want to get health insurance as members of the senate, they go on to this exchange for federal health care -- for federal employees and select which plan works best for their families. so we want everybody to be able to access that and choose which plan works best for them and if they can't afford it, even though we would have a lot of bargaining power and we would be able to get the same kind of rates that really big companies

are able to get, or the federal system is able to get, some people still will not be able to provide it and then we would provide subsidies and there would be certain rules governing any insurance company that's participating. you couldn't exclude for preexisting conditions, you couldn't exclude -- you couldn't have a lifetime cap. you would have to limit out of pocket expenses, so alt insurance rules i talked about, that would be part of the deal if you as an insurer wanted to sell insurance through this exchange. so far so good. the argument around public, one of the choices on range be a public option. the idea here would be that a government-run not for profit would have its own option that people could sign up for. they wouldn't have to -- but they could sign up for it and if it could keep its cost lower and provide a good quality of service and good benefit, then that would help keep the

insurance companies honest. because the idea being that as a not for profit, potentially would lower administrative cost, they could do a good job. now, the insurance companies have come back and said, well, that's not fair because nobody can compete against the government. they have a legitimate point if, if what's being done is the government is either subsidize ing that government plan, essentially taking taxpayer money and saying, here, we'll keep on spending money regardless of whether you run a good operation or not, then it's hard for insurance companies to compete against that. and by the way, it would be wildly expensive for taxpayers. i have already said a public option could only -- can only work if they have to collect premiums premiums and compete on a level

playing field. that's point number one. the second argument that's been made is the one that you just made which is if public option is reimbursing at medicaid rates, that are substantially lower than what private insurers have to negotiate for, then eventually over time, private insurers might be run out of business. so that's the second argument. what's happened in the house bill that as it's been modified is they've actually said we're going to negotiate rates so it won't be medicaid rates that. actually solves the problem that you're addressing because now this would be a negotiated process and prices would not be set just for medicaid. all right? now, there is a third argument against the public option and this is the one really that you've been hearing mostly about and that is just this idea that we shouldn't have government involved at all, that government is part of the problem. not part of the solution. to quote ronald reagan.

we've got supporters of that view. and i guess -- i think you can have a legitimate position, just saying you don't want to see more government involvement. i understand the argument. the only thing i would point out is that medicare is a government program that works really well for our seniors and -- hold on one second. don't start yelling. it's true that it's expensive, but the truth is, actually the cost of medicare inflation has actually gone up at a slower rate than private insurance. so it's not because it's mismanaged. it's because of what was referred to in the first question, the whole health care system is out of whack and way too expensive. it's not government per say. it has to do with the fact that the health care system itself,

the delivery system are not working the way they should. so if you just believe the government shouldn't be involved in anything, or shouldn't be involved in health a care, period, then you're right. you can't support the kind of reform that we're proposing. the only thing i want to make sure of is you make an honest argument 'cause nobody is talking about government takeover of health care. there is a difference between what we're proposing which has some government involvement versus this idea that somehow government is going to take over everything and get between you and your doctor. that's not what we're proposing. so we can have a disagreement, but i want to be clear on what the debate is about, it's about this narrow issue of the public plan, it's not about somehow eliminating private insurance. everybody who has private insurance that works for them will be able to keep private insurance under the proposals that have been made in congress. all right? okay. it's a woman's turn.

young lady right there with the vest. yeah. that's you. >> hello, mr. president, thank you for being here. i'm a student. being as i am a potential health care provider in the health care system, there are a few things in the plan that i read about that i wanted to understand more as far as providers being required to report preventible medical errors in the health care system. as far as health care systems are concerned, we are required to report every error we see. so i kind of want a clarification you are expecting

from provider as soon as. >> different states have different rules. so we've got a patchwork. i confess, i don't know exactly what the rules are here in colorado. but about 100,000 people die every year from preventible diseases and illnesses in hospitals. some of the ways that we could solve this are so simple. there is actually a doctor who put together a protocol, washing your hands, a lot of just basic stuff that costs no money, that has been shown repeatedly to have cut these preventible illnesses and deaths down drastically that by a magnitude of 50%, 75% reduction in preventible deaths just by applying these things that don't cost any money. so the question then becomes,

how do we get more hospitals, more doctors, more health system s to adopt these systems? the best way to do is it to make sure that not only are they reporting these preventible errors, but they're also available to consumers, the american people, so that if they got too many of them, after a while they start getting embarrassed. right? if you found out that there are two hospitals here in this city and one hospital has half the preventible deaths of the other hospital, you would want to know that, wouldn't you? the problem is right now, oftentimes it's very hard for a consumer to get that information directly. so the idea is simply to make sure that that information is packaged in a way where you can comparison shop and your employer, if you're getting health insurance through your employer, can comparison shop

and put competitive pressure in to improve the quality to improve the system. that's what we're talking about. by the way, thank you for being a nurse, 'cause we need more nurses. that's important. all right. gentleman right here in the t-shirt. hold on one second. we got a mic coming. >> thank you for coming to colorado. it's a great place. >> it's a great place. >> you touched on this, i would like you to expand a little more. this problem with misinformation in our country, it seems to me that it's not only hurting health care reform, health insurance reform, it's dividing our country. is it not maybe time -- i think we all know where it's coming

from. is it not time that something can be -- okay. i got to watch what i'm saying. >> look. let me just address this. health care is really hard. this is not easy. i'm a reasonably dedicated student to this issue. i've got a lot of really smart people around me who have been working on this for months now. we've got really fine public servants like senator bennett and udoll who are working on this and thinking about it a lot. and the truth is, i want to be completely honest here -- there is no perfect, painless silverbullet out there that solves every problem, gives

everybody perfect health care for free. there isn't. i wish there was. i wish i could just say, you know what, we're going to change the system. everybody will get as much care as they want any time they want, everybody will have it and it won't cost anything. and doctors will be happy and nurses will be happy. hospitals will be happy, insurance companies will still make a lot of profit. drug companies will be able to charge as much as they want. i can't do it. nobody can. what i can do is try to sort through what are all the options available, be realistic about where we're going on health care, say to myself, if we keep on doing what we're doing, we are in a world of hurt. we can't afford what we're doing

right now. more people are going to lose health insurance. more employers are going to drop coverage or push more coverage onto their employees with higher premiums and higher deductibles. medicare and medicaid will go broke. state bubbling jets and federal budget also be unsustainable. and then we're going to have to make really bad decisions where we have no good options, even worse options than we have right now. what's going to end up happening is, manager my words, if we do nothing, at some point, medicare in eight to nine years, goes into the red, going broke, yeah, it is going broke. here is what's going to happen if we don't change the delivery system and change some of the incentives, we'll have a choice. we'll either have to cut medicare, in which case seniors will bear the brunt of it, or we'll have to raise taxes, which nobody likes. we still will be paying about five to $6,000 more than any

other advanced country in the world and not get better health care for it. now, that doesn't make sense. so in terms of misinformation, because there is no perfect solution, we can have legitimate debates about the public option that we just had. that was a good, serious debate and you can make a plausible argument as to why the public option -- it's not perfect. it's not going to solve everybody problem, but i think it actually would keep the insurance companies more honest. you can have an honest disagreement with me on that. what you can't do or you can, but you shouldn't do, is start saying things like you want o set up panels to pull the plug on grandma. i mean, come on. i mean, -- first of all, when yu

make a comment like that, i just lost my grandmother last year. i know what it's like to watch somebody you love, who is aging, deteriorate and have to struggle with that. so the notion that somehow i ran for public office or members of congress are in this so they can go around pulling the plug on grandma? i mean, when you start making arguments like that, that's simply dishonest, especially when i hear the arguments coming from members of congress in the other party who, turns out, sponsored similar provisions. here is what this was about.

here was the genesis of this little piece of information. we had a provision in the house that would give the option, the option of somebody getting counseling on end of life care or hospice care and have it reimbursed by medicare. the option, voluntary so that you would have more information about how to deal with the situations. turns out the biggest proponent of this was a republican congressman who was a senator and colleague of mr. udoll and mr. bennett. turns out in medicare part b, which was passed by a republican congress, they had the exact same provision. so when i have people who just a couple years ago thought this was a good idea now getting on television suggesting that it's a plot against grandma or to

sneak euthanasia into our health care system, that feels dishonest to me and we've got enough stuff to deal with without having these kinds of arguments. all right. [ applause ] a woman's turn here. sort of neglected this area right here. young lady right there, blond hair, black dress. right there. >> hi, my name is julie, i'm a small owner from -- business owner from colorado brings. i'm also a republican who voted

for you. >> thank you. >> what's your business? >> we make software. >> we need that. >> i hope so. i grew up in a blue collar family and my husband and i work very hard at our business. we've always treated our employees like family, given them great benefits and any time they need off with their family, i volunteer my professional community, at my children's school and that's still not enough because a small business owner is on that cusp between middle class and the rich are going to bear the brunt of what this will cost. why is what i do now not enough? >> let me -- i think it's a good question. let me talk about both cost and what this would mean for small businesses, because both issues would affect it. first of all, remember what i

said, i can't come up with a perfect solution that is completely free. it is absolutely true that in order for us to provide help to those who have no insurance at all, that's going to cost some money. it's going to cost some money. we can't do it for free. they've got no health insurance right now, we're going to help them, 46 million people. it's going to cost some money. now, what i propose is going to cost roughly $900 billion. 800 to 900. that's a lot of money. keep in mind, it's over ten years. so when you hear it will be figures thrown out there, it's not per year, this is over ten years. let's assume it's about $80 billion. it turns out that about two-thirds of that could be paid for by eliminating waste in the existing system. let me give you one pick

example. we right now provide $177 billion over ten years for about 17, $18 billion a year to insurance companies in the forms of subsidies for something called medicare advantage where they basically run the medicare program that everybody else has, except they get an extra bunch of money that they make a big profit on. and there is no proof, no evidence at all that seniors are better off using medicare advantage than regular medicare. if we could save that $18 billion a year, that is money that we could use to help people who right now need some help. so about two-thirds of what we're talking about is paid for through the existing health care system, money that's already being paid by taxpayers.

does not require additional taxes. but that still leads one third. now, in order to pay for that, there have been a lot of proposals out there. one of them that i propose, i still think is the best idea, you may disagree 'cause i don't know what your income bracket is. my proposal was that for people making more than $250,000 a year, people like myself, that we should, instead of getting the full itemized deduction of what our highest tax bracket is, we should cap out on itemized deduction at 28%, which is what the average american gets. because my attitude is, i shouldn't get a bigger tax break if i write a check to my local church than if the janitor down the street writes a check to their local church. we should get the same tax break. if we were willing to do just that alone, just that alone

would pay for what we're talking about. now, some members of congress disagree with that and they've got other proposals. that's going to be worked out in september. i do want to make the point, though, that i have not proposed any plan that would put the burden on middle class families in order to deal with this. so when you hear people talking about i'm raising your taxes, the only tax policies i've implemented for middle class family social security is a tax cut for 95% of working families. now, let me talk about small businesses. i don't know your particular situation, whether you're providing health insurance right now to your employees. if you are, and you stand to benefit from this plan because every proposal, both in the house and the senate that's been put forward, provides a huge number of subsidies to small business owners that are doing the right thing by their employees. so it is very likely --

obviously we would have to look at the calculations. i would have to figure out how many employees you have, what kind of health insurance plan you have, et cetera, but it is very likely that you would actually make money, gain from this plan because you're already providing health insurance to your employees and we would give you some help. the only category of folks who might not like this plan are employers who can afford to provide health insurance to mayor employees, but aren't doing so, because what we would then say to them, is, look, we're giving you affordable options. you are going to be able now to be part of a bigger pool. you can buy your health insurance through that exchange that i was explaining to that gentleman there. so you'll be able to get premiums and prices that are comparable to what big company

ies, xerox or ibm are getting for their employees, and we'll give you some help doing it. but if you refuse to provide any health insurance for your employees at all, then we are going to ask you to make a contribution to help make sure those employees have health insurance. because by the way, it turns out if you as an employer are not providing that health insurance, the rest of us are, because those folks are going on medicaid or they're going to the hospital for uncompensated care and that's not fair. [ applause ] so the bottom line is this: if you are a small business person who is providing health insurance for your employees, i am very sure that you would actually benefit from this. but the problem is, again, this is where the information has not been going out in as clear a fashion as possible, which is

why i'm glad you asked the question. all right? okay. i just want proof here -- i'm happy to get a good debate going. >> how are you doing, mr. president? >> what's your name? >> glam lane -- zach lane. studying political science and business marketing. >> what's your question? >> i love to have a debate, all out any time, oxford style if you would like. i'm willing to do that. my question is this: we all know the best way to reduce prices in this economy is to increase competition. how in the world can a private corporation providing insurance compete with the entity that does not have to worry about

making a profit, does not have to pay local property taxes, they are not subject to local regulations? how can a company compete with that? i'm not looking for anything -- i don't want generalities. i'm just asking a question. >> that's a great question. thank you for the question. i just want to point out that i partially answered the question earlier by explaining that certainly they can't compete if the taxpayer is standing behind the public option just shoveling more and more money in. right? that's certainly not fair. so i've already said i would not be in favor of a public option of that sort because that would just mean more expenses out of our pockets and we wouldn't be seeing much improvement in quality. it is true that there are certain costs associated with a

private business that a government would not have to worry about. you mention add couple of them. it's not just, by the way, property taxes. it's also things like just the cost of capital. in terms of the cost of borrowing a public option -- insurance companies have to have a lot of money on hand and it's conceivable that a private entity that's having to pay a certain interest rate for their money would be really undermined if the government is able to get money much cheaper just because uncle sam backs this operation. so that's why i say, this is actually algate -- legitimate debate. i think we can craft a system in which you got a public option that has to operate independently, not subsidized by taxpayers. it would be nonprofit, but we've already got not for profits out there like blue cross, blue

shield, that they would have to go on the market and get a market price for capital. so they wouldn't have the federal reserve write them a check. i think there are ways we can address those competitive issues. you're right, if they're not entire israeli addressed, then that raises a set of legitimate problems. the only point i wanted to make was the notion that somehow just by having a public option, you have the entire private marketplace destroyed is just not borne out by the facts. and, in fact, right now, you've got a lot of private companies who do very well competing against the government. ups and fed-ex are doing a lot better than the post office. they are. # and so -- the larger point i want to make -- it's good to see a young person who is very

engaged and confident, challenging the president to an oxford style debate. i think this is good. this is good. i like that. you got to have a little hootspa. this is a legitimate debate to have. all i'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform. this is just one sliver of it, one aspect of it. by the way, it's both the right and the left that have become so fixated on this that they forget everything else, like the fact that we can help nathan make sure that he doesn't suddenly find himself completely broke in trying to treat his son. so we are working on a series of proposals to address the questions that you're raising.

i believe that we can work them out, but those are specific questions as opposed to a broad philosophical question about whether government ever has a role to play or not. keep in mind, finally and this is the last point i'll make -- that you have a bunch of countries that have systems in which government is involved, but you still have a thriving private insurance market. the netherlands being a good example. everybody is covered, everybody has care. the government has regulations in there, but it does not somehow take over the entire private insurance system. i want people to understand, nobody is talking about a government takeover of health care. i want to repeat that one last time. all right. i've got one last -- time for one last question.